What is the hospital reality?

"There is a lot of misunderstanding about what hospitals really can do. Patients need to understand our goals and our limits," says Georgiana White, a wise former head nurse on a unit at Massachusetts General Hospital, now a teacher of patients' rights and patient advocacy at the Harvard School of Public Health and Harvard Medical School.

"I think hospitals sometimes overpromise. We promise to 'take care of you,' when in fact we're unable to take care of all your personal needs. With cost containment, a hospital has become mainly a place for performing tests and procedures, and what hospitals ought to tell patients today is: We're going to do some specific procedures in the safest way possible in the shortest time possible. We are not reimbursed for lengthy stays, so we must cram as much as possible into each day."

Because of cost controls and limits on who may be hospitalized, "the patients in the hospital are sicker," she points out, "and our technologies are more and more sophisticated. This demands a very highly trained staff.

"The new technologies require many specialists and consultants, and the idea of a physician who cares for you throughout your hospitalization may be rare.

"This can be very confusing to you, particularly if no one is interpreting it all. I think most patients feel there's a mechanistic attitude toward them, that there's more concern with monitoring the technology than with what's happening to them.

"You may be undergoing intravenous feeding. It may be what you need. But it doesn't feel as though something good is happening to you -- you may just feel bad, threatening things are happening.

"About the nurses today. Modern nursing too requires high technology, so we have super-nurses with sophisticated training. However, there is very little time for comfort at the bedside."

Yet, she adds, "So many things are better. We can handle the sick better. We know how to measure, how to do fluid replacement. We know how to do some wonderful things, and we have armies of patients who would have been dead a few years ago. Your heart stops -- we start it up again. It's all rather miraculous.

"We are able to get you out of the hospital faster. In fact, we send you home before you get to know the pace of the hospital, and with the cost controls, this is only going to get worse. We send you out before you're well. You have to finish getting well on your own."

How to cope with some of these realities?

She suggests that you:

Visit the hospital, if you can, before a stay to get a sense of where things are, so you won't be so disoriented.

Read up on hospital stays. (Two good books, among others, available in some libraries: "The People's Hospital Book" by Ronald Gots and Arthur Kaufman, Crown, 1978, and "The Hospital Experience" by Judith Nierenberg and Florence Janovic, Bobbs-Merrill, 1978.)

"Learn to work the hospital" by learning to use the doctors, nurses and a more recent addition found in many hospitals: the patient representative. More on these persons in future columns.